Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study.
Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study.
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COPD患者自杀念头的患病率和相关性：一项混合方法研究。
DOI：
10.2147/copd.s65507
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发表时间：
2015
影响因子：
2.8
通讯作者：
Borson S
中科院分区：
文献类型：
--
作者：
Fleehart S;Fan VS;Nguyen HQ;Lee J;Kohen R;Herting JR;Matute-Bello G;Adams SG;Pagalilauan G;Borson S
本研究的目的是检查稳定的中度至极重度慢性阻塞性肺疾病（COPD）患者自杀意念（SI）的患病率及其相关性。我们对一项慢性阻塞性肺疾病抑郁症纵向观察研究的参与者的数据进行了探索性混合方法分析。我们测量抑郁症患者健康问卷-9（PHQ-9），其中包括一个项目的SI。我们用独立的t检验和卡方检验比较了有和没有SI的参与者在社会人口统计学、症状、焦虑和医疗资源使用方面的差异。对结构化SI安全性评估期间收集的定性数据进行内容分析。在202名参与者中，121名（60%）有抑郁症状（PHQ ≥ 6）; 51名（25%）有PHQ-9 ≥ 10，表明当前重度抑郁的可能性很高; 22名（11%）报告了SI。与99名没有SI的抑郁症参与者相比，SI患者更可能是女性（59% vs 27%，P = 0.004）;呼吸困难加重（P = 0.009），抑郁（P <0.001），焦虑（P = 0.003）;也更有可能接受过抑郁和/或焦虑的治疗（82%比40%，P <0.001）和更多的COPD急性加重住院治疗（P = 0.03），但与无SI的参与者相比，气流阻塞和功能水平相似。SI患者的定性分析主题包括当前或以前的不良生活状况，未经治疗或部分治疗的复杂抑郁症，关键关系的丧失，疾病和残疾的经历，以及与供应商的沟通不畅。我们的研究结果表明，当前SI在COPD中很常见，可能不成比例地发生在女性中，尽管接受了心理健康治疗，但仍可能持续存在，并且与健康和生活事件有着复杂的关系。因此，COPD患者SI的充分管理可能需要量身定制的综合治疗方法，将医疗和心理健康目标相结合。
The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI) in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD). We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9), which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Of 202 participants, 121 (60%) had depressive symptoms (PHQ ≥6); 51 (25%) had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11%) reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004); had worse dyspnea (P=0.009), depression (P<0.001), and anxiety (P=0.003); and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001) and more hospitalizations for COPD exacerbations (P=0.03) but had similar levels of airflow obstruction and functioning than participants without SI. Themes from the qualitative analysis among those with SI included current or prior adverse life situations, untreated or partially treated complex depression, loss of a key relationship, experience of illness and disability, and poor communication with providers. Our findings suggest that current SI is common in COPD, may occur disproportionately in women, can persist despite mental health treatment, and has complex relationships with both health and life events. Adequate management of SI in COPD may therefore require tailored, comprehensive treatment approaches that integrate medical and mental health objectives.